Electrocardiograph



Oct. 13, 1953 w WOOD 2,655,425

ELECTROCARDIOGRAPH riled Feb. 25, 1950 2 Sheets-Sheet l INVENTOR Hzrzze W ood ATTORN Oct. 13, 1953 H. w. WOOD ELECTROCARDIOGRAPH 2 Sheets-Sheet 2 Filed Feb. 25, 1950 w d wll a m q FNWMsm JL MN WW0 n T rN Ill MHW v l m 1 T. I I I I I I I I I I I l W auamm mfi H m g Q2 g g "H. m NM, m m" m W fi I 62 u \Q I ll i m l1 d| 3 ms M g n 8 Nfi 3 m Q9 m mm m 1 R3 S: fig g MN: III. I II I I DA IT I I I I I I I I I I I I I 111% Patented Oct. 13, 1953 UNITED STATES PATENT QFFECE ELE CTROCARDIOGRAPH York, N. Y.

Application February 25, 1950, Serial No. 146,255

9 Claims. 1

This invention relates to the calibration of electrocardiographs and like electrical recording equipment. More particularly it relates to ap paratus for making calibrating or test marks on the record sheet of direct-recording instruments, as distinguished from photographic type recorders.

A cardiographic record of heart conditions is obtained by plotting voltages developed in the human body. Such plots are often obtained by photographic systems employing string galvanometers. Apparatus of this type produces an excellent record, but because the trace is invisible until the photographic film is processed, the results of the electrocardiographic examination are not immediately available.

Thus, there are obvious advantages of directrecording electrocardiographs, in which the voltage from the patient is amplified electronically and used to drive a recorder, in which a pen, or other type of stylus, traces the electrocardiogram on a moving sheet or strip. The unit can be con structed with such small dimensions that it can be conveniently carried about, and it does not require the use of film processing apparatus, the

graph being immediately visible as it is being traced.

A direct-recording system of this type, is useful even though it will not provide as accurate data as the more precise photographic systems, and it is not a complete replacement for the photographic system, but rather is a valuable adjunct for use in connection therewith.

The electrocardiogram must not only accurately represent the body voltages, but it must present the data so that it can be interpreted readily in terms of set standards, so that some system of calibration must be provided on the record. In the best electrocardiographs of the photographic type, time reference lines are provided by periodically interrupting a light beam, so that time ref erence lines are accurately interrelated independently of other variations, such as the speed of the film.

In stylus recorders, reference marks are usually printed on the chart paper on which the electrocardiogram is to be inscribed. The accuracy of the calibration of the reference marks representing the time axis of the graph depends up on the speed with which the chart paper moves past the recording stylus.

It is not commercially practical to rely on a so-called constant-speed chart-driving system to maintain the necessary accuracy. Such drive systems are expensive, and are not readily incorporated in portable equipment in which the frequency and voltage of the available power sources may vary to considerable extent. Moreover, even if the chart-driving system did maintain a constant speed, it would be necessary to take precautions against errors such as would be caused by dimensional changes in the chart paper after the reference marks had been printed on it, for example, because of humidity changes.

In accordance with the present invention, a system is provided for recording calibrating marks directly upon the electrocardiogram. The invention contemplates the use of a mechanically oscillating body for controlling the application of a calibrating voltage to cause periodic deflections of the recording stylus. These calibrating marks can be correlated readily with any time reference marks printed on the chart to check the accuracy or to establish suitable correction factors to be applied when the chart is interpreted. Another aspect of the invention is directed to the provision of a standard calibrating voltage, which is applied and controlled by the mechanically oscillating body, so that the amplitude of the calibrating marks will serve as a basis for voltage calibration of the instrument. Another aspect of the invention relates to the arrangement of a single device to produce both voltage and time calibration. Another aspect of the invention relates to the application of the calibrating marks in the form of substantially square waves to provide simultaneous information regarding the performance of the amplifier. Another aspect of the invention relates to the automatic discontinuance of the calibrating marks after a desired period of time. Still another aspect of the invention relates to an arrangement which permits the instrument to be calibrated while the patient is connected in the circuit.

In an illustrative embodiment of the invention, a vibrating reed alternately closes and opens two electric circuits which connect a source of standard voltage, first with one polarity and then with the opposite polarity, to an electronic ainplifier which controls the deflection of a recording stylus.

These and other aspects, objects, and advantages of the present invention will be apparent from a consideration of the following description taken in conjunction with the accompanying drawings in which:

Fig. 1 is a perspective View of a portable electrocardiograph embodying the invention; and

Fig. 2 shows, diagrammatically, the electrical circuits of the electrocardiograph shown in Fig. 1.

The electrocardiographic voltages are picked up by a conventional arrangement of contact electrodes (not shown) which are applied to the patient and connected to a plug I (Fig. l) in the side of a carrying case 2 which houses the electrocardiograph. These voltages are applied to two input terminals i and 5 (Figure 2) of a twostage, push-pull amplifier, generally indicated at Ii. The amplified signal voltages control the balance of a vacuum-tube bridge circuit, generally indicated at 3, which operates a recording mechanism, generally indicated at I2. When the bridge circuit 8 is unbalanced by the application of patient voltages to the terminals 4 and 5, the bridge circuit causes lateral deflection of a recording stylus It (see also Fig. 1), which may be a pen, but which is shown in Fig. 1 as a heated stylus that produces a visible trace on a moving strip of heat-sensitive chart paper I6. A calibrating arrangement, generally indicated at I8 (Figure 2), is controlled by a rockably mounted lever 29 (see also Figure l) and provides electrical impulses for producing time calibrating marks on the chart paper It so that the distance between adjacent marks corresponds to a known time interval, and the amplitude of these calibrating marks represents a known voltage at the input to the amplifier 6. As shown in Fig. l, the chart paper It is provided with printed reference marks 22 and as which correspond, respectively, to the time and voltage coordinates.

In the amplifier 6, the input terminal 6 is connected directly to a control grid 28 of an input tube at, and input terminal 5 is connected through two series resistances 32 and 34 to a 5 control grid 35 of an input tube 38. The cathodes 4t and 42 of these tubes are connected together and returned to ground through a common bias resistor 44.

The anodes 45 and 48 of the tubes 39 and 33 are connected, respectively, through two plate load resistors 56 and 52 to a positive terminal 5 of a conventional rectifier-filter power supply, indicated in block form at 55, which is connected through a switch 51 to a plug 58 (see also Fig. 1) by which the power supply is connected to the usual alternating current supply mains.

The signal voltages appearing at anodes lit and 48 are coupled through two coupling condensers (it and 62 to control grids 5 and iii, re-

spectively, of two push-pull, voltage-amplifying tubes es and it. Grid return circuits are pro vided by resistors i2 and M which are connected between grids Eli and 56, respectively, and. ground.

The cathodes iii and E8 of these tubes are ccnnected to ground through a. common biasing resistor 88. The suppressor grids 82 and $4 of these tubes are connected to their respective cathode ircuits, and the screen grids se and 83 are con ected together and through a voltage-dropping resistor at to the positive terminal 5 of the power supply 56. Positive voltage is provided for the anodes 9! and er of these tubes through plateload resistors 33 and 94, respectively, which are connected to the positive power supply terminal 54.

The signals appearing at anodes SI and. 92 are coupled, respectively, through two coupling condensers [I32 and HM to two sensitivity-control potentiometers I08 and I08, the adjustable contacts I i2 and I Id of which are connected, respe tively, to control grids H5 and N3 of bridgeamplifier tubes I22 and I124. The adjustable contacts H2 and H4 of the potentiometers I05 and I08 are ganged. together mechanically and adjusted manually by means of a control knob I25 (Fig. l), which controls the sensitivity of the amplifier system. This control arrangement is such that the magnitudes of the signals applied to the two grids I I5 and I I8, increase or decrease in unison. The other ends of potentiometers I08 and W8 are connected, respectively, to opposite ends of a potentiometer IZIi, the adjustable contact I28 of which is connected to a negative bias supply terminal I N on the power supply 56. The ends of potentiometer i2ii are connected also to ground through resistors I32 and I3d.

The adjustable contact I23 of potentiometer 825 is adjusted by means of a ositioning-control knob I35 (Fig. 1) and controls the lateral position of the recorded trace with respect to a center 'eference line I35. This adjustment simultaneously varies the bias voltages of the bridge amplifier tubes I22 and I24 in opposite directions, so that the relative currents through these tubes can be adjusted to secure the desired balance condition of the output bridge circuit 8 that controls the recording mechanism I2.

The two bridge amplifier tubes I22 and IE are arranged, in conjunction with two auxiliary bridge tubes 53% and I463, to form a bridge network which drives the recorder 52. The cathodes I42 and IM of the bridge-amplifier tubes E22 and I24 are connected together and to ground through a constant current ballast tube its series with a fixed resistor Hit. The ballast tube stabilizes the operation of the circuit against changes that would be caused by line voltage fluctuations.

The screen grids Ml and Hit of the tubes I22 and I24 are connected together and through voltage-dropping resistor I52 to a second positive terminal 556 on the power supply 5%, which is arranged to deliver a higher positive voltage than terminal 54. The anodes I56 and I53 of these tubes are connected through load resistors 55% and Hit to cathodes IE6 and itB or" the two auxiliary bridge tubes 535 and it'd, respectively, and also through isolating resistors 1'52 and IN to control grids Iifi and I18 of the tubes I33 and Hit, respectively.

The screen grids I82 and IE4 of the tubes I38 and I40 are connected to the anodes I85 and I88, which are connected together and to the positive supply terminal let. The suppressor grids I89 and I9!) are connected to the cathode circuits of the respective tubes. A galvanometer coil I92 of the recorder l2 controls the deflection of the stylus It and is connected between the cathodes I66 and I68 of the auxiliary tubes I38 and Me.

With this arrangement the tubes I38 and I22 are effectively connected in series to form one branch of the bridge, and tubes Idil and I24 are effectively connected in series to form the other branch of the bridge circuit. So long as the bridge amplifier tubes I22 and 124 carry equalcurrents, and the two auxiliary tubes 13d and I40 are carrying equal currents, no voltage will appear betweenthe cathodes I55 and I58 of tubes I38 and Hit, and no current will flow through the galvanometer coil I92. However, if the control grid, say, of the first bridge amplifier tube I22, becomes more positive, the plate current flowing through this tube increases, increasing the voltage drop across the resistor I62 and causing an increased negative voltage on control grid I15 of the auxiliary tube I38 with respect to its cathode it. This increase in negative bias increases the effective plate impedance of tube [38 and reduces the flow of current through that tube.

However, with a balanced signal, as the grid H6 of the tube I22 becomes more positive, the grid II8 of the other bridge amplifier tube I24 becomes more negative by a corresponding amount, and accordingly the plate current of this tube is decreased, thus reducing the voltage drop across the load. resistor 464, and driving grid I'I8 of auxiliary tube I46 in a positive direction to reducethe efi'ective plate impedance of the latter tube. It is now seen that the. effect of a signal having the above polarity is to reduce the plate impedances of tubes I22 and I46 and to increase the plate impedances of tubes I24 and I38. Thus, the principal current flows from power supply terminal I54 through the. tube I46, the galvanometer coil I92, the load resistor I62, and the tube I22 to ground. When the polarity of the applied signal is reversed, the plate impedance of the tubes I24 and I38 is decreased and the plate impedance of the tubes I22 and I40 is increased correspondingly, so that current. flowsthrough coil I92 in the opposite direction. The input signal controls only the bridge amplifier tubes I22 and I24, which, in turn, respectively, control the auxiliary tubes I38 and I46. Thus, the impedances of all four arms of the bridge arrangement are simultaneously controlled, providing maximum efiiciency and maximum variation in current through the galvanometer coil I62 with minimum energy dissipation in the circuit. This arrangement provides its greatest advantages when the bridge circuit drives a current-operated device, such as the recorder I2.

In order to pull the chart paper I6 past the stylus I4, an electric motor I94 is provided which drives a roller I96 that is in frictional contact with paper I6.

Calibration of the recorder is provided according to the present invention by a reed, indicated diagrammatically at 244, which is uniformly resilient throughout its length, and which is supported at one end with its opposite end free. When deflected and'released the reed vibrates with simple harmonic motion having a predetermined period; As shown, a weight 246 is added to the end of the reed with the effect of lengthening its period. When this reed is set in motion it periodically'and alternately closes two electrical circuits, at a rate depending upon the natural period of the reed 2 44, and its pendulum Weight 246. These circuits intermittently impress a standard voltage on the recording element so that a series of transverse lines, comprising the continuous s uare-wavecalibrating pattern 2I, are

recorded on'the chart paper I6, the amplitude of the waves representing the predetermined and known input voltage and the spacing between corresponding points on successive waves indieating a predetermined and known time interval.

In order to deflect the reed to initiate the vibration, the control lever 26 is pivotally mounted so that it can be conveniently rotated manually in the direction indicated by the arrow until it strikes a stop 252. As the lever 2il is rotated it deflects the reed 244 toward the right, as viewed in Fig. 2, and then slides over the end of the reed to release it and permit its harmonic vibration. The lever 29 also closes switch contacts 254 and 2-56 and maintains them in this position so long as the lever 22 is in its counter-clockwise position. During the calibration the input terminals 4 and 5 may be short-circuited. However, it is an advantage of the present arrangement that the apparatus can be calibrated while the patient possibility of changes occurring between the time the calibration marks are made and the time the electrocardiogram is made.

The circuit as shown assumes the patient to be in the circuit during calibration so that the usual ground return is provided through the right leg of the patient. However, as pointed out above, the input terminals can be short-circuited and a suitable ground return circuit provided through a resistor.

The calibrating circuit can be traced from a terminal 258 of a standard galvanic cell 262, or other source of voltage of known potential, through the switch contacts 254 and 256 to the vibrating reed 244 which carries a contact 264 that, when the reed vibrates to the right, as viewed in Fig. 2, makes contact with a contact member 266 to complete the circuit through the load resistor 34 and a current-limiting resistor 268 to the other terminal 212 of the standard cell 262.

When the reed 244 vibrates to the left, as viewed in Fig. 2, reed contact 264 makes contact with a contact member 274, completing the circuit from terminal 258 of the standard cell 282 through the reed 244, the contact member 274, the load resistor 32 and the current-limiting resistor 263 to the other terminal 212 of the standard cell 262. Thus, when the reed 244 is deflected to the left, the voltage of standard cell 262 is impressed across the resistor 32, and thus is applied to the amplifier input with a first polarity, and when it is deflected in the opposite direction this voltage is impressed across resistor 34, and thus again applied to the input circuit, but with reversed polarity. In this manner, the voltage from the standard cell 262 is applied to the input circuit, first with one polarity and then with the reverse polarity, and at a rate dependent upon the natural p riod of reed 244. The reed in this case is representative of the well understood class of devices which vibrate or alternate with harmonic oscillation. Obviously, others of this class such as a pendulum in any 01? its various forms, a balance wheel and hairspring, etc, may be used; but I have found particular advantage in the rugged simplicity and permanent stability of the reed as shown.

It is apparent that the standard voltage will be impressed on the input circuit only so long as the lever 26 is maintained in counter-clockwise position to hold the contacts 2% in en-- gagement, and that when the lever is released, to return to its original position, the standard voltage will no longer be impressed upon the input circuit. In addition, the arrangement of the rotatable lever 26 is such that the reed 244 is given the same initial deflection each time the lever is rotated.

The maximum number of calibration marks that will be recorded depends upon the length of time the lever is maintained in its counter-clockwise position or upon the time the reed 244 sustains suiiicient vibrating am itude. If additional calibrating marks are desired, the lever 26 is merely returned to its initial position and again rotated in a counter-clockwise direction, and if less than the full number of calibrating cycles is desired, the lever 29 is r turned to its initial position, thus opening the contacts and to prevent the standard volta e from bein impressed upon the input circuit.

With this arrangement, the time and voltage calibration of the instrument can be checked is connected in the circuit, thus precluding any It quickly and rapidly whenever it is desired to do so,

irrespective of. wheth r; the patient is in or out of the circuit;

The calibration system. described above. also provides a check on: the performance of. the; amplifier; The calibration signal generated by the vibra ng reed: isa substantially square-wave form, and the repetition frequency is relatively low, a few cycles per second, so: that by observing. the recorded wave form a fair idea of the frequency response characteristics of the amplifier can be obtained.

Thus, by operation of a single control knob the technician can simultaneously inscribe accurately controlled. time and voltage calibration marks upon the eiectrocardiogram.

I claim:

1, In an eleetrocardiograph, or the like, calibrating apparatus comprising an electronic arnplifierhaving. input and output circuits; a recorder connected to u out circuit for recordi magnitude of the v ge applied to circuit as a function a source of standa1 rzing potent a resilient vibratable member, manually controlled for initiating vibration of said member, a circuit for coupling. said standardizing source to input circuit, circuit being normally-open sai vibratahle member and at said manual init ng means,

rst switch means, under the control of said initiating means, for closing circuit at that point, and second switch means, under the control of said vibratable member for periodical-1y completing said circuit thereby to apply a pcriodic standardizing voltage to said input circuit.

2 In an electrocardiograph, or the like, calibrating apparatus comprising an electronic amplifier having input and output circuits, an. indicator connected to said output circuit for indicating the magnitude of the voltage applied to said input circuit as a function of time, a source of standar .ng potential, a harrnonically moving element, a first, normally-open circuit for coupling said standardizing source to said input circuit with a first polarity, a second, normallyopen circuit for coupling said standardizing source to said input circuit with a second polarity, first and second switch contacts under the control of; said harmonically moving element for alternately completing said first and second circults, thereby to apply a standardizing voltage of periodically reversing polarity to said input oncuit.

3. In an electrocardio r ph, or the like, calibra-ting apparatus comprising an electronic am- CIR a circuit, normally-open as at said reed and at input circuit at predetermined time intervals and thus to calibrate both the time and voltage 00- ordinates cf the record produced.

4. In an electrocardiograph, or the'like; calibrating apparatus comprising an electronic amplifier having inputv and output circuits; a recorder connected to: said output circuit for indicating the magnitude of the voltage applied to said input, circuit as a function of time, a source of standardizing potential, a vibrator reed, a manually controlled movable arm for initiating vibration of; said reed, a first, normally-open circuit for coupling said source to said input circuit with a first polarity, a second, normally-open circuit for coupling said. source to said input circuit with a second polarity, a first switch member under the control, of said arm for partially completing said first and second circuits, second and. third switch, members under the control of said harmonicallymoving element for alternately completing said first and second circuits, thereby to. apply a standardizing voltage of periodically reversing polarity to said input circuit.

5. Apparatus as described in claim 4 wherein said second and third switch members are spaced on opposite sides; of the relaxed position of said reed, a distance corresponding to a fraction only of the amplitude, initially established by said movable: arm, whereby they make contact only duringan initial fraction of the" time during which it is vibrating.

6'. Apparatus as described in claim 3 including a weight supported by said reedfor increasing its period.

7. In an electrocardiograph, or the like, standardization apparatus comprising a resilient reedl-ike member, one end thereof being rigidly mounted and the other end free to vibrate, a Weighted member carried by said reed for increasing the natural period of said reed, a standard cell, a first, normally-open circuit for coupling said standard cell to said input circuit with a first polarity, a second, normally-open circuit for coupling said standard cell to said input circuit with a second polarity, a manually-operable, rotatably-mounted lever positioned adjacent said reed and arranged to deflect and then release said resilient reed upon rotation thereof in a first direction, a switch responsive to said rotation of said lever for partially energizing said first and second circuits, and first and second contact members positioned on opposite sides of said reed and spaced therefrom and adapted alternately to complete said circuits in response to vibration of said reed, thereby to apply constantvoltage constant-frequency pulses of reversing polarity to said input circuit.

8. In an electrocardiograph, or the like, time and magnitude calibrating apparatus including an electronic amplifier having input and. output circuits, manual means for varying the amplification of said amplifier, a recorder connected to said output circuit for indicating the magnitude of the voltage applied to said input circuit as a function of time, said recorder including a continually moving record medium and means for feeding said recording medium, a standard cell, a harmonically moving element independent of said record medium feeding means, and: circuit means under the control of said element for periodically connecting said standard cell to and disconnecting it from said input circuit for producing a series of voltage pulses, thereby to permit adjustment of said amplification control means and calibration of said record feeding means in accordance with predetermined calibration standards.

9. In an electrocardiograph, orthe like, wherein a trace is produced on: amoving record medium having a center reference line, apparatus for calibrating the time and magnitude scales of said trace and for centering said trace on said record medium, said apparatus including an amplifier having input and output circuits, manual means for adjusting the amplification of said amplifier, a recorder including said moving record medium and having means for feeding said medium, said recorder being connected to said output circuit for producing said trace on said medium indicating the magnitude of the voltage applied to said input circuit as a function of time, manual means for adjusting the lateral position of said trace with respect to said center line, a standard cell, a vibratable reed, manual means for initiating vibration of said reed, a pair of switch means under the control of said reed and responsive to the excursions of said vibrating reed in opposite directions for periodically connecting said standard cell to and disconnecting it from said input circuit, said switch means being arranged to make said connections with successively opposite polarity for producing a series of square wave voltage pulses for operating said recorder to produce a trace having time calibrating marks crossing said center reference line, thereby to calibrate the speed of said record feed means and to permit adjustment of said amplification control means and said lateral position adjustment means in accordance with the trace produced by said recorder in response to said voltage pulses.

HARVEY W. WOOD.

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